Healthcare Provider Details

I. General information

NPI: 1780152769
Provider Name (Legal Business Name): REBECCA ZINKOWSKI RD, LD, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 09/11/2025
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3175
US

IV. Provider business mailing address

15 BRAMHALL ST APT 4
PORTLAND ME
04102-3122
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-9030
  • Fax:
Mailing address:
  • Phone: 603-793-3221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0926
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: